Molecular epidemiology of penicillin-non-susceptible Streptococcus pneumoniae isolates from children with invasive pneumococcal disease in Germany (original) (raw)
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Journal of Clinical Microbiology, 2001
A total of 128 Streptococcus pneumoniae isolates that were susceptible to penicillin but resistant to non-lactam agents were isolated from young carriers in Greece and analyzed by antibiotic susceptibility testing, serotyping, restriction fragment end labeling (RFEL), and antibiotic resistance genotyping. The serotypes 6A/B (49%), 14 (14%), 19A/F (11%), 11A (9%), 23A/F (4%), 15B/C (2%), and 21 (2%) were most prevalent in this collection. Of the isolates, 65% were erythromycin resistant, while the remaining isolates were tetracycline and/or trimethoprim-sulfamethoxazole resistant. Fifty-nine distinct RFEL types were identified. Twenty different RFEL clusters, harboring 2 to 19 strains each, accounted for 76% of all strains. Confirmatory multilocus sequence typing analysis of the genetic clusters showed the presence of three international clones (Tennessee 23F -4, England 14 -9, and Greece 6B -22) representing 30% of the isolates.
1998
A total of 26% of the pneumococci isolated from an outpatient clinic in Nairobi, Kenya, during 1991Kenya, during to 1992 had intermediate levels of penicillin resistance. Gene fingerprinting and DNA sequencing were used to distinguish the penicillin-binding protein (PBP) LA, 2B, and 2X genes in 23 resistant isolates. Isolates were grouped into those that had identical forms of each of the three PBP genes (fingerprint groups) and those that had identical rRNA gene restriction patterns (ribotypes). Both methods divided the isolates into 11 groups. In a few cases, horizontal gene transfer appeared to have distributed an identical altered PBP gene into different pneumococcal lineages. Eight isolates were indistinguishable by ribotyping or multilocus enzyme electrophoresis and contained identical PBP LA genes. Although these isolates were therefore members of the same clone, they were divided into two fingerprint groups which contained different PBP 2X and 2B genes. Presumably, members of this clone have acquired different altered PBP 2X and 2B genes on two separate occasions. One of these fingerprint groups contained isolates of serotype 14, whereas the other contained isolates of both serotypes 14 and 7. The identification of isolates in the latter group that are identical by all criteria, except serotype, implies the occurrence of a change in serotype. The predominant serotypes of the penicillin-resistant pneumococci from Nairobi were serotypes 14 and 19. In both cases, isolates of the same serotype which required the same MIC of penicillin were not members of a single clone, indicating that identity of serotype and MIC are not sufficient criteria for defining clones of resistant pneumococci even when the bacteria are isolated from a single clinic.
Zentralblatt für Bakteriologie, 1998
This study was aimed to define the carriage rates for Streptococcus pneumoniae in a given population in Ankara and also to determine the serotypes and penicillin resistance of these strains. Oropharyngeal swabs were taken from a total of 661 children aged between 0-11 years and living in a province of Ankara between January 1995-January 1997. Serotyping was performed by detection of the Quellung reaction. The isolates were screened for penicillin susceptibility by the agar dilution method according to the guidelines of NceLS. The total rate of pneumococcal carriage in the study population was 23.90% and the isolation rate was found to be statistically associated with age, being higher in small children. Among the 158 S. pneumoniae isolates, the most prevalent serotypes (in order of frequency) were 6, 19,9,23,3 and 14. Penicillin susceptibility was examined in 120 of the isolates. 55 of them (45.83 %) were susceptible, 53 (44.17%) were intermediately and 12 (10.0%) were highly resistant to penicillin. Evaluation of the results showed that serotypes 6, 14 and 23 were those most often associated with penicillin resistance. The significant rate of isolation of penicillin-resistant pneumococci in healthy carriers points to the importance of active immunization in risk groups and also the importance of the rational use of antibiotics to limit the spread of resistant strains.
Molecular epidemiology of penicillin-resistant Streptococcus pneumoniae isolated in central Taiwan
Diagnostic Microbiology and Infectious Disease, 1998
A total of 26% of the pneumococci isolated from an outpatient clinic in Nairobi, Kenya, during 1991Kenya, during to 1992 had intermediate levels of penicillin resistance. Gene fingerprinting and DNA sequencing were used to distinguish the penicillin-binding protein (PBP) LA, 2B, and 2X genes in 23 resistant isolates. Isolates were grouped into those that had identical forms of each of the three PBP genes (fingerprint groups) and those that had identical rRNA gene restriction patterns (ribotypes). Both methods divided the isolates into 11 groups. In a few cases, horizontal gene transfer appeared to have distributed an identical altered PBP gene into different pneumococcal lineages. Eight isolates were indistinguishable by ribotyping or multilocus enzyme electrophoresis and contained identical PBP LA genes. Although these isolates were therefore members of the same clone, they were divided into two fingerprint groups which contained different PBP 2X and 2B genes. Presumably, members of this clone have acquired different altered PBP 2X and 2B genes on two separate occasions. One of these fingerprint groups contained isolates of serotype 14, whereas the other contained isolates of both serotypes 14 and 7. The identification of isolates in the latter group that are identical by all criteria, except serotype, implies the occurrence of a change in serotype. The predominant serotypes of the penicillin-resistant pneumococci from Nairobi were serotypes 14 and 19. In both cases, isolates of the same serotype which required the same MIC of penicillin were not members of a single clone, indicating that identity of serotype and MIC are not sufficient criteria for defining clones of resistant pneumococci even when the bacteria are isolated from a single clinic.
Antimicrobial Agents and Chemotherapy, 1982
This study examined the resistance to penicillin, tetracycline, erythromycin, and chloramphenicol of 318 pneumococcal strains isolated in Spanish hospitals from blood or cerebrospinal fluid of patients during 1979 to 1981. The serotypes of these strains were determined to discover whether a correlation between serotype and patterns of antibiotic resistance could be found. Seven and nine patterns of resistance were found in strains isolated from blood and cerebrospinal fluid, respectively; tetracycline was the most frequent pattern, followed by tetracycline associated with chloramphenicol. A random distribution of serotypes which was similar to the general distribution of serotypes was found for resistance to tetracycline and chloramphenicol, but penicillin-resistant strains were confined to seven serotypes. Thirty-six strains of penicillin-resistant pneumococci isolated from sources other than blood or cerebrospinal fluid were also serotyped. They represented the same serotypes, sug...
Emergence of Streptococcus pneumoniae with Very-High-Level Resistance to Penicillin
Antimicrobial Agents and Chemotherapy, 2004
Core surveillance of the Emerging Infections Program Network to document the emergence in the United States of invasive pneumococcal isolates with very-high-level penicillin resistance (MIC > 8 g/ml). Veryhigh-level penicillin resistance was first detected in 1995 in multiple pneumococcal serotypes in three regions of the United States. The prevalence increased from 0.56% (14 of 2,507) of isolates in 1995 to 0.87% in 2001 (P ؍ 0.03), with peaks in 1996 and 2000 associated with epidemics in Georgia and Maryland. For a majority of the strains the MICs of amoxicillin (91%), cefuroxime (100%), and cefotaxime (68%), were >8 g/ml and all were resistant to at least one other drug class. Pneumonia (50%) and bacteremia (36%) were the most common clinical presentations. Factors associated with very highly resistant infections included residence in Tennessee, age of <5 or >65 years, and resistance to at least three drug classes. Hospitalization and case fatality rates were not higher than those of other pneumococcal infection patients; length of hospital stay was longer, controlling for age. Among the strains from 2000 and 2001, 39% were related to Tennessee 23F -4 and 35% were related to England 14-9. After the introduction of the pneumococcal conjugate vaccine, the incidence of highly penicillin resistant infections decreased by 50% among children <5 years of age. The emergence, clonality, and association of very-high-level penicillin resistance with multiple drug resistance requires further monitoring and highlights the need for novel agents active against the pneumococcus.
Differentiation of Penicillin Susceptible and Nonsusceptible Streptococcus pneumoniae
Introduction: Streptococcus pneumoniae (S. pneumoniae) cause morbidity and mortality in infants and younger children. Because of high prevalence of penicillin resistance, rapid and reliable diagnostic techniques for penicillin non-susceptible S. pneumoniae (PNSSP) are important for prevention and treatment. We investigated the association of the restriction length polymorphism (RFLP) patterns for pbp2b to distinguish between penicillin susceptible and resistant S. pneumoniae isolates. Methods: In this study, a total of 70 pneumococcal isolates were collected from different clinical sources. MIC of these isolates was determined and pbp2b gene was amplified by PCR and they were digested by HaeІІІ enzyme. Results: Of the 70 isolates, 86% (60) and 14% (10) pneumococcal isolates were found to be PNSSP (penicillin intermediate S. pneumoniae (PISP) and penicillin resistant S. pneumoniae (PRSP)) and penicillin susceptible S. pneumoniae (PSSP). In addition, 10 RFLP patterns (A-J) which were ...
European Journal of Clinical Microbiology & Infectious Diseases, 2004
consecutive invasive strains of Streptococcus pneumoniae were isolated from children under 16 years of age in four hospitals in suburban Paris. Their genetic diversity was investigated by serotyping and analysis of pulsed-field gel electrophoresis restriction patterns. Antibiotic susceptibility patterns were analysed by disk susceptibility testing and determination of minimal inhibitory concentrations. The genetic basis of macrolide resistance was investigated by polymerase chain reaction. Studies of penicillin and vancomycin tolerance were performed for each strain. Despite the high prevalence (45.2%) of penicillin-nonsusceptible Streptococcus pneumoniae, resistance to amoxicillin (1.4%) was rare, and no strain was resistant to cefotaxime. Overall, 4.1% of pneumococcal strains were resistant to penicillin. Penicillin or vancomycin tolerance was not detected in any of the 73 strains studied. Of the erythromycin-resistant strains (48%), all but one carried the ermB gene. No strains showing a decreased susceptibility to ciprofloxacin (MIC, >4 mg/l) or overexpressing an efflux pump inhibited by reserpine were isolated. The serotypes found, in order of frequency, were as follows: 18C, 14, 6B, 19F, 19A, 9V, 23F, 1, 7F, 9A, 38. Strains of penicillin-nonsusceptible Streptococcus pneumoniae belonged predominantly to serotypes 14, 6B, 9V, 9A, 23F, 19F and 19A. The seven-valent conjugated vaccine covered 85.5% of the serogroups isolated in children under 2 years of age and 65.6% of the serogroups identified in children over 2 years of age. The genetic analysis showed a high identity for some serotypes, such as 14/9V, 6B and 23F. The use of the seven-valent conjugated vaccine is a critical measure to prevent invasive pneumococci infections in children in the Ille de France area.
Microbial Drug Resistance, 1998
From January 1993 through December 1996,1,252 Streptococcus pneumoniae strains from different geographic regions of Brazil were studied for penicillin (Pen) susceptibility. All pneumococci were isolated from normally sterile fluids from patients, newborns to 88 years old. Pen resistance (R) had a mean rate of 15.1%, with 14.5% of strains showing intermediate level Pen-R and 0.6% showing high-level Pen-R. Similar Pen-R rates were observed in different regions of the country, in the range of 9.5% to 17.1%. A Pen-R increase was noted from 9.6% in 1993 to 20.6% in 1996. Pen-R was mostly associated to serotypes 6B, 14, 19A, and 23F (89%). Chromosomal DNA relatedness of Pen-R strains was determined by pulsed field gel electrophoresis (PFGE). High genetic diversity was identified, being represented by 27 patterns among the 92 strains. Two important features were observed: the predominance of relatively low-level Pen MIC (range 0.1-0.5 mg/L) in 86 of the 92 strains, and the presence of 60.8% as four major PFGE clusters unique to Brazil. Another feature was the geographic spread of these clusters over large distances in the country. The city of Säo Paulo seems to be a Pen-R focus (18.4%) in Brazil. Only two strains representing the international clone B widely spread in France, Portugal, and Spain, belonging to serotype 14, were found. 209 210 BRANDILEONE ET AL. tries such as South Africa,20 Hungary,22, and Spain21,24 and were shown to spread to other parts of the world (clonal spread), e.g., to the United States,23,36 Iceland,30 and Croatia.32 Such pneumococci with close genetic relatedness are referred to as the international clones of S. pneumoniae. In general, these clones comprise highly Pen-R-and multidrug-resistant strains and share a common capsular serotype.24,30,35
Journal of Antimicrobial Chemotherapy, 2004
Objectives: To determine the epidemiological relationship between non-invasive penicillin nonsusceptible Streptococcus pneumoniae isolates collected in the Christchurch community between 1997 and 2001. Methods: One hundred and ninety-seven pneumococcal isolates were examined by macrorestriction profile analysis of SmaI-digested genomic DNA separated by PFGE and restriction fragment length polymorphism analysis of penicillin binding protein genes. Results: Four major clonal lineages were identified, the largest and most homogenous containing 95 (48.2%) of the isolates, the bulk of which (93.7%), had identical macrorestriction patterns. Members of this clonal group were multidrug-resistant and exhibited high resistance to third-generation cephalosporins, with MICs > _ 8.0 mg/L not uncommon (23.1%). Two of the clonal groups, each containing 24 (12.2%) isolates, appeared indistinguishable from the globally widespread Spain 23F-1 and France 9V-3 strains, respectively. The fourth (12.7% of isolates) multidrug-resistant clone possessed intermediate penicillin susceptibility (MIC 0.12 mg/L). Conclusions: This study shows that several distinct penicillin-resistant pneumococcal clones are present in the Christchurch community, most of which appear to have been imported into New Zealand.